年龄调整后的 Charlson 和 Elixhauser-Van Walraven 合并症指数在预测心脏瓣膜手术患者预后方面的价值。

IF 1.5 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiothoracic Surgery Pub Date : 2024-10-25 DOI:10.1186/s13019-024-03116-9
Xingping Lv, Xiaobin Liu, Chen Li, Wei Zhou, Shuyue Sheng, Yezhou Shen, Tuo Shen, Qimin Ma, Shaolin Ma, Feng Zhu
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引用次数: 0

摘要

研究目的本研究旨在比较年龄调整查尔森合并症指数(ACCI)和Elixhauser-Van Walraven合并症指数(ECI-VW)在预测心脏瓣膜手术患者死亡风险方面的有效性:使用 R 语言从 INSPIRE 数据库中提取临床数据。方法:使用 R 语言从 INSPIRE 数据库中提取临床数据,利用接收者操作特征曲线(ROC)评估 ACCI 和 ECI-VW 对院内全因死亡率和手术后 7 天和 28 天全因死亡率的预测准确性。为验证应用效果,还进行了分组分析,并确定了最佳临界值:研究共纳入 996 例患者,其中 931 例存活,65 例院内全因死亡。ACCI预测院内全因死亡率的曲线下面积(AUC)为0.658(95% CI:0.584,0.732),而ECI-vw预测相同结果的曲线下面积(AUC)为0.663(95% CI:0.584,0.741)。在预测术后 7 天内的全因死亡率方面,ACCI 的 AUC 为 0.680(95% CI:0.04,0.56),ECI-vw 为 0.532(95% CI:0.353,0.712)。关于术后 28 天内全因死亡率的预测,ACCI 的 AUC 为 0.724(95% CI:0.622, 0.827),ECI-vw 为 0.653(95% CI:0.538, 0.69)。根据 ACCI 临界值 3.5 将患者分为两组,包括第一组(ACCI 3.5 分,173 例)。采用 Kaplan-Meier 法计算了这两组患者的总生存率,结果显示,第 1 组患者的术后 28 天生存率明显高于第 2 组患者(P 结论:ACCI 对术后 28 天生存率有显著的预测作用:ACCI 对心脏瓣膜病手术后 28 天内的院内全因死亡率具有重要的预测价值。与 ACCI 小于 3.5 的患者相比,ACCI 大于 3.5 的患者在术后 28 天内的死亡风险更高。这一发现表明,ACCI 可以作为评估接受此类手术干预的患者预后的初步工具。
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The value of Age-adjusted Charlson and Elixhauser-Van Walraven comorbidity index in predicting prognosis for patients undergoing heart valve surgery.

Objective: This study aims to compare the efficacy of the Age-adjusted Charlson Comorbidity Index (ACCI) and the Elixhauser-Van Walraven Comorbidity Index (ECI-VW) in predicting mortality risk among patients undergoing heart valve surgery.

Methods: Clinical data were extracted from the INSPIRE Database using R language. The Receiver Operating Characteristic (ROC) Curve was employed to assess the predictive accuracy of ACCI and ECI-VW for in-hospital all-cause mortality and post-surgical all-cause mortality at 7 and 28 days. Subgroup analysis was conducted to validate the application efficacy, and the optimal cutoff value was identified.

Results: The study included 996 patients, with 931 survivors and 65 cases of in-hospital all-cause mortality. The area under the curve (AUC) for ACCI in predicting in-hospital all-cause mortality was 0.658 (95% CI: 0.584, 0.732), while the AUC for ECI-vw in predicting the same outcome was 0.663 (95% CI: 0.584, 0.741). For predicting all-cause mortality within 7 days post-surgery, the AUC of ACCI was 0.680 (95% CI: 0.04, 0.56), and for ECI-vw, it was 0.532 (95% CI: 0.353, 0.712). Regarding the prediction of all-cause mortality within 28 days after surgery, the AUC for ACCI was 0.724 (95% CI: 0.622, 0.827), and for ECI-vw, it was 0.653 (95% CI: 0.538, 0.69). Patients were categorized into two groups based on the ACCI cutoff value of 3.5, including Group 1 (ACCI < 3.5 points, 823 cases) and Group 2 (ACCI > 3.5 points, 173 cases). The overall survival rate for these two patient groups was calculated using the Kaplan-Meier method, revealing that the 28-day postoperative survival rate for patients in Group 1 was significantly higher than that for patients in Group 2 (P < 0.0001).

Conclusions: ACCI demonstrates significant predictive value for in-hospital all-cause mortality within 28 days following cardiac valve disease surgery. Patients presenting with an ACCI greater than 3.5 exhibit an increased risk of mortality within 28 days post-surgery compared to those with an ACCI less than 3.5. This finding suggests that the ACCI can serve as a preliminary tool for assessing the prognosis of patients undergoing this type of surgical intervention.

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来源期刊
Journal of Cardiothoracic Surgery
Journal of Cardiothoracic Surgery 医学-心血管系统
CiteScore
2.50
自引率
6.20%
发文量
286
审稿时长
4-8 weeks
期刊介绍: Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.
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